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�ERMIT APPLICATI� <br />BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOL,ITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br />ITE ADDRE$S��� S� hv!"'S 7�CJ�- <br />�� <br />EGAL for new construction: Short PlaUsubdivision <br />OWNER <br />Haaress 5 �v�yj � <br />APPLICANT: Owner _ Owner's Agent _ Contractor _ <br />CONTRACTOR �� ���� �G <br />Address l J 3�� p� �-S�N� /�,^�j <br />BUILDING PERMIT APPLICATION <br />TAX # <br />No. (attach copy of Ibng legal description) <br />Phone/E-mail <br />�� �-g <br />ICity/State/Zip <br />Contractor�s A9Bf11 _ Tef18f1Y (must provide a letter of consenl from the owner lo qp work in ihe space) <br />State Lic. # ��J2,L�{O,�%K/ City Bus. Lic. # � ��'f �� <br />�/1 /vlZ� Phone/Email �C ('i�l h �ri» C IGC 17"K � /�Jsrl . �G <br />i <br />CONTACT FOR PERMIT <br />Phone/E-mail �us SC � ( 1 1L��� �� � 'y0 �— �l � <br />CONTRACT PRICE OF WORK i���� -rl��" <br />Existing Use of Building � <br />Proposed Use of Building <br />Building type; ,_ Single Family _ Duplex _Townhouse _ Multi-Family ,_ Commercial <br />Type of project: New Addition _ Remodel Repair _ T.I. _ Sign _Sprinkler <br />DESCRIPTION OF WORK (additional space provided on the back) : <br />� �� ��cJ y'i-.�-�r e s v/�- <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />� Boiler <br />� i Refrigeration <br />� Woodstove <br />I Ducting <br />� Other <br />SPRINKLER / SUPPRESSION SYS' <br />Number of Heads <br />HEAT SOURCE: <br />_ Electric Other <br />olition Change of Use <br />MIT APPLICATIO <br />Type of Project: _New _Addn _Alteration _Repair <br />Show Number (#) of fixtures <br />1 Toilet <br />Kitcnen sinK r� c <br />Dishwasher <br />Clothes washer <br />Water heater <br />�inKing rc <br />oor drain <br />Roof drains <br />Medical Gas <br />Other: <br />Other: <br />n <br />I hereby certify that I have read and examined this a' tion and know ihe same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied <br />with whether specifi erein or not. The gra ' of a p mit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br />That I am authori d ihe owner of t' r erty p orm the work for which application is made and I comply with the State Contractors Law 16.27 RCW and 296200A WAC. <br />� `-/� /.�� <br />Owner/ thorized Agent Signature Date (Revised 4/2015) <br />